Yes. The situation in the Netherlands in that respect is quite different, because you have to realize a couple of things. If you look at the situation of the pharmacies in the Netherlands, it has not improved over the last years. And that’s due to the fact that there is much more competition and also due to the fact that the amount of profit which has been generated in the pharmacies, has been substantially reduced over the last years.

The earning model for a standalone pharmacy is changing rapidly and is also at this moment very insecure, what the earning model will be next year and the year after that.

It’s quite insecure at this moment due to the fact that we have a sort of a fixed reimbursement system at this stage for the service from the pharmacies. But that model is going to change in the future. For instance, they wanted to change that for the 1st of January 2012, where our Ministry of Health has said “Ok, we want to have free fees or negotiated fees by the pharmacies” and not fixed fees which are set by a Dutch authority, called the Dutch Healthcare Authority. This regulation has been postponed now and won’t be applicable from the 1st of January 2012. It will probably will be delayed to 2013, but that’s not sure yet. What you have to realize on the other side is that, for example, if you look to the service fee paid towards the Dutch pharmacists, that’s a fixed fee at this stage, which is partly negotiable, and it’s negotiable for an amount of 25% approximately. I will give you an example. If a pharmacy delivers a recipe for, let’s say, a mean recipe, he receives a mean fee of 7,50 Euros, which can be negotiated due to the fact that the delivery of extra service towards the patient, to 10 Euros per recipe.

That’s the current situation. That has come down from 7,91 Euros in 2010. The point that you would like to make is it is pretty insecure what the future earning model will be of a pharmacy standalone.

No, no, the example I have given you is that of the pharmacies in the Netherlands. For example, if he has dispensed a recipe to a patient, he is allowed to get a fee for that, and that fee he gets from the insurer. And the discussion point at this stage is the fee is quite, let’s say, the fee is a big part of the profit for the pharmacists. The level of the fee is quite important for the pharmacist. And the pharmacist can negotiate plus on the current fee of 2,50 Euros. The maximum fee he is allowed to get is 10 Euros. And this extra amount can be negotiated with the insurer if the pharmacist supplies extra services to the patient. I will give you an example, for example, if a pharmacist will count my blood pressure and he also monitors ***, and for that service he can sit together with the insurer *** and negotiate an extra fee. You understand what I mean?

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But what you also see is that also for the regular pharmacy in a village, that pattern has also changed a little bit now, because of internet pharmacies.This is more convenient instead of driving half an hour to get your prescription by your closest pharmacy.

.Selective distribution is another issue.

It’s another issue, yes. But what we see nowadays is that the whole distribution channel is quite changing. There are new initiatives, I can’t predict at this stage if there will be other new initiatives in the future, but the expectation also is, if you look at the number of pharmacies we nowadays have in the Netherlands, which is approximately 2.000, that there is quite a possibility that this number will come down and that we will end up with a model, but that’s a little bit speculative at this stage, but then we will end up with a model where the number of pharmacies will be reduced substantially and other distribution channels will take part of the burden of the pharmaceutical services.

But if you look at local pharmacies that will be probably reduced.

the income for the pharmacies retail , will decrease substantially because the Dutch government is of the opinion that the distribution of the pharmacies in the Netherlands should be less expensive than it is today.

Let’s say, well, what you see is that we have a couple of chains in the Netherlands which are having quite a strong market position. On the other hand, let’s say, the biggest number are still independent pharmacies. And you see initiatives at that side to act also as collectivity, and that is quite heavily supported by the biggest retail wholesaler in the Netherlands, and that’s a wholesaler in the southern part of Netherlands called ***. And what you see is that their market position has increased over the last 10 to 15 years. They were one of the very small retailers at that stage and they have the biggest market share now.

They doubled their numbers in the last two years,

Yeah, approximately, approximately. What you see is that, let’s say, privately owned pharmacies are having a very close relationship with this wholesaler. And this wholesaler also on a national level represents the interests of those partly owned pharmacies.

No, no, no. I would certainly argue against that, because if you look at the companies who bought chains of pharmacies, they have invested in *** a substantial amount of *** until 2005.

In 2005, *** chain expanded p approximately till 2005, afterwards, due to the fact that the interference of the government was more and more *** and the profit model changed substantially. And what you see is that for example, the *** company who invested in 2130 pharmacies, and if you look at the profit they made on the investment that they made, that it is far lower than they expected. Due to the fact that they bought the pharmacies and again, let’s say, *** quite high prices.

the standalone pharmacy by itself, without being connected to a collectivity, it’s very hard for them to survive in the next five years I think.

Yeah, yeah, that’s also what I expect. That’s an issue that more and more happens of course, because pharmacies in the Netherlands are quite traditional from a standpoint of behaviorj there are also good exceptions but normally spoken they are not *** oriented as they should be.

The loyalty of patients is not increasing but it is decreasing. And the pharmacies have been put in a perspective from the patients’ side of view as ordinary money makers. And it’s quite difficult for them to change that view.

And if you look at the turnover of this pharmacy, that’s approximately 2.500.000 Euros.

No, no, no. That’s a normal turnover. Obviously you have to buy your medications. And the margin is approximately about 15% - 20%?

Let’s make it roughly around that amount, yes.

Or a bit more higher.

No, no, no, certainly not higher.What you have to realize is you make a margin but on the other hand there is situation in the Netherlands where you have to hand over part of this margin to the insurance company.

In addition to that, for each recipe you supply to the patient, you get a fee. So in the end what you have to count together is the purchase of the drugs and then the reimbursement of the drugs, and then the margin you make by supplying the stuff to the patients, you get from the insurer again. Let’s say we have quite very different pharmacies, in a turnover perspective, in the Netherlands. So what you see at this stage is that there where a regular pharmacy in the past made profits of 200.000 to 300.000 Euros a year, that have substantially come down now to, and they diminished their profit with the cost, to zero profit or let’s say 100.000 Euros profit. (Aυτό που εννοεί είναι ότι το περιθώριο κέρδους στα φαρμακεία στην ολλανδία συναποτελείται πέρα από την κατα αποκοπήν αμοιβή , και επιπλέον από εκπτώσεις που παίρνουν στα φάρμακα.Όσο πιο μεγάλη η έκπτωση τόσο μεγαλύτερο το περιθώριο κέρδους.Τα ασφαλιστικά ταμεία όμως απαιτούν τις εκπτωσεις που παίρνουν οι φαρμακοποιοί να τις αποδίδουν και αυτές και έτσι φτάνουν τα φαρμακείαστην Ολλανδία να μην έχουν περιθώριο κέρδους αλλά να στηρίζουνται σχεδόν αποκλειστικά στο κατ'αποκοπήν.)

Break even. It’s close to zero.

It’s close to zero nowadays and it can be, but it depends also a little bit if a pharmacist has bought a pharmacy, he has paid goodwill for that, and goodwill he has to pay out of the profit he is making. And due to the fact that the profit has come down substantially and if he has bought the pharmacy, still they bought for a very high price, he can run into difficulties in paying his goodwill. Εννοεί ότι ειδικά αν ο φαρμακοποιός έχει πληρώσει υπεραξία για το φάρμακείο επειδή το αγόρασε (και μετά σου λένε ότι μόνο στην ελλάδα πουλάνε άδειες) το κέρδος του στην ουσία είναι μηδενικό γιατί το απορροφά η απόσβεση της υπεραξίας.

The margin on the stock that you sell is approximately 20%, but the overall net result is close to zero.

What we explained already is that if you look at the pharmacists, they generate an income, so with this income he can live. If you look to the chains of pharmacies, the income of the pharmacist is sometimes substantially lower. And if a chain of pharmacies they can, let’s say, reduce costs overall. And what they have done in the last one to one-and-a-half year is they have substantially, and wherever possible, reduced personnel costs. What they have also done is they have tried to find ways, for example due to central filling where the repeated medication is centrally made, also reduced their costs. And via these ways, they generate some extra profit.

Inthe past, if you look to the way the Dutch pharmacist earns his money, that was due to the substantial amount of profit he made on the generic drugs. And the generic drugs at that time were priced at the level of the specialty products. But due tointerference of the Dutch Authority, those prices have gone down substantially. Some prices have been reduced by for example 90%. (Eδώ λέει ότι παλιότερα τα αντιγραφα και η χορήγηση με δραστική αποτελούσαν πηγη εισοδήματος για το φαρμακείο.Η κατακόρυφη πτωση όμως των τιμών των αντιγράφων έριξαν το εισοδημα του φαρμακοποιού)

This interference has substantially reduced the profit figure of the local pharmacies and obviously also the profit model of the chain owners.

When I first started working in the pharmaceutical market, the wholesaler margin -that was in 1985- the wholesaler had a margin of let’s say 15 to 20%. And I worked for a wholesaler myself, and at that time the margin had already gone down to approximately 10%.

The wholesaler's margin nowadays is more between 6% to 7% instead of 10%, and that is due to the fact that the manufacturer more or less has the ability, if there is no competition in terms of generic products or *** products, to set the margin for the wholesaler. The wholesaler's margin is free. That’s a negotiation between the wholesaler and the manufacturer.

And the added value of the wholesaler in the Dutch distribution channel is reducing since years and is still reducing. So that’s why the margin has come down substantially.

Some manufacturers work already with a system, so let’s say you get just a fee for delivery and not a fee based on a percentage of the cost of the product. (Mερικές φαρμακοβιομηχανίες δε δίνουν καν στο χονδρέμπορα ποσοστο κέρδους αλλά επι της ουσίας τα έξοδα διανομής)

Τhat depends mainly a little bit on the way, on how they interpret the Dutch figures, or the way the Dutch system operates. But I can assure you that if you look to the figures of Dutch wholesalers, profit margins are, let’s say, between 0% and 1%, and some of them between 0% and -1%.

For instance if someone open a pharmacy today in the first five to ten years will not make any profit. The profit will come afterwards. Let’s calculate it in quite a good way, we would say we have to write it off in ten years, I expect you will make profit after 10 years.The picture for the earning model is changing rapidly and is pretty insecure for the next two years and afterwards. That’s what I can tell you. I hope provided you with a good insight in the Dutch market